Implementation of a novel patient reported experience measure (PREM) in rheumatology: a cross-sectional online survey of Australian rheumatology outpatients

Madeleine J Bryant; Susan Lester; Oscar Russell; Samuel Whittle; Vidya Limaye; Susanna Proudman; Rachel J Black; Catherine L Hill

doi:10.1007/s00296-025-05882-8

Implementation of a novel patient reported experience measure (PREM) in rheumatology: a cross-sectional online survey of Australian rheumatology outpatients

Rheumatol Int. 2025 May 8;45(6):138. doi: 10.1007/s00296-025-05882-8.

Authors

Madeleine J Bryant^{1

2

3}, Susan Lester^{4

5

6}, Oscar Russell^{4

5

6}, Samuel Whittle^{4

5

6}, Vidya Limaye^{4

7}, Susanna Proudman^{4

7}, Rachel J Black^#^{4

5

7

6}, Catherine L Hill^#^{4

5

7

6}

Affiliations

¹ School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia. Madeleine.Bryant@sa.gov.au.
² Rheumatology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, 28 Woodville Road, Woodville South, SA, Australia. Madeleine.Bryant@sa.gov.au.
³ Rheumatology Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia. Madeleine.Bryant@sa.gov.au.
⁴ School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.
⁵ Rheumatology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, 28 Woodville Road, Woodville South, SA, Australia.
⁶ Rheumatology Research Group, Basil Hetzel Institute for Translational Health Research, 37 Woodville Road, Woodville South, South Australia, Australia.
⁷ Rheumatology Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia.

^# Contributed equally.

Abstract

To determine rheumatology patient care experience using the novel Commissioning for Quality in Rheumatoid Arthritis-PREM-Australian version (CQRA-PREM-AU). Patients attending Central Adelaide Local Health Network rheumatology outpatient clinics were invited to complete a cross-sectional web-based survey, comprising CQRA-PREM-AU (22 items, 8 domains, scored 1-5), demographics, Patient Global Assessment (PGA) and Patient Reported Disease Activity (PRDA) Visual Analogue Scales (VAS) (scored 0-100), Single Item Literacy Screener (SILS). Analysed were multivariable linear regression analysis of CQRA-PREM-AU overall score with patient-related covariates (diagnosis, age, sex, SILS, PGA, PRDA), and univariate regression analysis with clinic-related covariates (site, nurse contact, type/number of consultations). Response rate was 1408/4591(31%). 214 incomplete records were excluded; 1194 records were analysed. Respondent characteristics: 68% female, median age 64 years (IQR 54, 73), 29% rural, 7% non-English language at home. PGA median score 50 (IQR 27, 63) and PRDA median score 50 (IQR 26, 69). CQRA-PREM-AU Domain 1 (regarding patient Needs and Preferences) had the best overall mean score (4.1, SD 0.86). Scored poorly were Domain 3 (Information about care, 3.5, SD 0.89), Domain 4 (Daily living, 3.5, SD 1.06) and Domain 5 (Emotional care, 3.6, SD 1.04). Worse PGA, and diagnoses of systemic lupus erythematosus, "other", or "unknown" were all associated with significantly lower CQRA-PREM-AU score (p < 0.01). Older age, and rheumatology nurse contact were associated with better experience score (p < 0.01). Use of CQRA-PREM-AU highlights the association between contact with a rheumatology nurse and better care experience, and identifies other targets for improving healthcare delivery.

Keywords: Outpatients; Patient care; Patient outcome assessment; Patient reported outcome measures; Rheumatology; Surveys and questionnaires.

MeSH terms

Adult
Aged
Arthritis, Rheumatoid* / diagnosis
Arthritis, Rheumatoid* / therapy
Australia
Cross-Sectional Studies
Female
Health Care Surveys
Humans
Internet
Linear Models
Male
Middle Aged
Outpatients
Patient Reported Outcome Measures*
Quality Indicators, Health Care* / standards
Rheumatology* / standards
Severity of Illness Index